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A New Era In Small Cell Lung Cancer Treatment

Dr. Debu Tripathy, editor-in-chief of CURE magazine, discusses the advancements made in small cell lung cancer.

Dr. Debu Tripathy, editor-in-chief of CURE magazine

Although advancements in treatments for small cell lung cancer (SCLC) are scarce for this aggressive cancer type, recent regulatory developments and trial results indicate that we are on the precipice of a new era for patients and providers alike.

We put a spotlight on these big steps forward and discuss what they mean for the future of SCLC treatment in this seasonal issue of CURE.

"The limited options of treatment for patients with small cell lung cancer is the reality that we all confront — but that is not for lack of trying," said Dr. Taofeek K. Owonikoko, executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore.

However, a glimmer of hope emerged with the approval of Imdelltra (tarlatamab-dlle) by the Food and Drug Administration (FDA) in May 2024 to treat patients with extensive-stage (ES) SCLC.

This groundbreaking immunotherapy, known as a bispecific T-cell engager therapy, offers an innovative approach to treating SCLC. Imdelltra works by binding to both cancer cells and immune cells, bringing them close together, which activates the immune system to attack and destroy the tumor.

Elsewhere this year, results of the landmark phase 3 ADRIATIC trial of Imfinzi (durvalumab), an immunotherapeutic antibody known as a checkpoint inhibitor, attracted plenty of attention in discussions at the American Society of Clinical Oncology Annual Meeting. The findings have also been published in the Journal of Clinical Oncology.

Imfinzi, which was initially approved by the FDA in 2020 in combination with etoposide and either carboplatin or cisplatin as first-line treatment of ES-SCLC, was tested in ADRIATIC in patients with limited-stage (cancer on one side of the chest only) SCLC and whose disease had not progressed after chemoradiotherapy.

"This is perhaps the only breakthrough advancement in the past 30 years, because we have been using chemotherapy and radiation to treat [patients with] limited-stage small cell lung cancer since more than 30 years ago. However, this is the first time a new treatment has been shown to be able to prolong life for almost two years," said Dr. Yuanbin Chen of the Cancer and Hematology Centers in Grand Rapids and Norton Shores, Michigan.

Imfinzi blocks the immune-dampening protein PD-L1, thereby helping the immune system detect and attack cancer. Based on the results of the ADRIATIC trial, the FDA has accepted a supplemental biologics license application for Imfinzi and granted priority review, with a regulatory decision expected later this year.

In discussing these developments, we also delve into the side effects associated with these treatments and acknowledge the continued need for a cure for SCLC — one of the more virulent cancers.

"We're still far, far away from where we need to be, which is, how do we transform cancer from being a very mortal diagnosis to something that people can survive?" said Owonikoko.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Palliative Care And Healthcare Utilization In Lung Cancer, COPD, And IPF At End Of-Life

Photo Credit: Magicmine

The following is a summary of "Differences in Healthcare and Palliative Care Utilization at the End of Life: a Comparison Study Between Lung Cancer, COPD, and IPF," published in the August 2024 issue of Pulmonology by Suen et al.

Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD) often experience significant symptom burden, diminished quality of life, and high healthcare utilization near the end of life. Although proactive palliative care integration is known to enhance outcomes for patients with lung cancer, similar practices for COPD and IPF remain underexplored. This study aimed to compare healthcare utilization and palliative care patterns between patients with these conditions in their final six months of life.

The researchers conducted a retrospective analysis of deceased patients with lung cancer, COPD, or IPF who had at least one outpatient visit at [removed] in their last six months. The study group examined and compared rates of outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths across the three groups. Multivariable logistic regression was employed to adjust for confounding variables, with lung cancer as the reference group.

The cohort included 1,819 patients, with those having COPD and IPF being notably older and predominantly male compared to their lung cancer counterparts. Analysis revealed that patients with COPD and IPF had significantly lower adjusted odds of receiving outpatient palliative care (COPD aOR: 0.26, 95% CI: 0.19-0.36; IPF aOR: 0.48, 95% CI: 0.32-0.70) and outpatient opioids (COPD aOR: 0.50, 95% CI: 0.40-0.63; IPF aOR: 0.40, 95% CI: 0.29-0.54) compared to patients with lung cancer (p < 0.001). Conversely, these patients exhibited higher adjusted odds of ICU utilization in their final days (COPD aOR: 2.88, 95% CI: 2.11-3.93; IPF aOR: 4.15, 95% CI: 2.66-6.49). Notably, patients with IPF had higher odds of receiving inpatient palliative care (aOR: 2.02, 95% CI: 1.30-3.13, p = 0.002) than the lung cancer group.

In conclusion, patients with COPD and IPF generally receive less outpatient palliative care and opioid treatment. They are more likely to experience ICU admissions at the end of life compared to patients with lung cancer. The findings highlight the need for improved palliative care integration in COPD and IPF management to align with practices seen in lung cancer care.

Source: sciencedirect.Com/science/article/abs/pii/S0012369224050499

Bristol Immunotherapy Improves Responses In Lung Cancer, Setting Up Phase 3 Study

BARCELONA, Spain — Adding a second immunotherapy from Bristol Myers Squibb to an existing checkpoint inhibitor and chemotherapy improved responses for certain patients with a type of lung cancer, steering the approach into a Phase 3 study. 

The Phase 2 RELATIVITY-104 trial was another hurdle for Bristol's Opdualag, which is essentially a combination of the company's powerhouse PD-1 inhibitor Opdivo and relatlimab, which targets another checkpoint called LAG-3. Opdualag is approved in advanced melanoma, but the drug has failed in some colorectal and liver cancer indications. The dose tested in the lung cancer study was higher than the one approved in melanoma.

The new study tested relatlimab with Opdivo and chemotherapy versus Opdivo and chemotherapy alone as a first-line treatment in advanced non-small cell lung cancer, with the aim to find which patients benefited from adding the anti-LAG-3 drug to the backbone of chemotherapy and immunotherapy, Samit Hirawat, Bristol's chief medical officer, told STAT. 

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